Salim v. Louisiana Health Serv. & Indem. Co., No. 22-30573, __ F. App’x __, 2023 WL 3222804 (5th Cir. May. 3, 2023) (Before Circuit Judges Higginbotham, Southwick, and Willett)
The three words no patient ever wants to hear from his or her health insurer are “not medically necessary.” These words can turn a lifesaving
The Ninth Circuit Giveth, the Ninth Circuit Taketh Away in Two Health Cases Against United
Ryan S. v. UnitedHealth Group, Inc., No. 20-56310, __ F. App’x __, 2022 WL 883743 (9th Cir. Mar. 24, 2022) (Before Circuit Judges Collins and Lee, and District Judge Jill A. Otake)
Wit v. United Behavioral Health, No. 20-17363, __ F. App’x __, 2022 WL 850647 (9th Cir. Mar. 22, 2022) (Before Circuit Judges Christen and Forrest, and District Judge Michael M. Anello)
We have two notable decisions this week; both are unpublished memorandum dispositions from the Ninth Circuit involving class actions against UnitedHealthcare and its affiliates.
Continue Reading The Ninth Circuit Giveth, the Ninth Circuit Taketh Away in Two Health Cases Against United
Wilson v. UnitedHealthcare Ins. Co., No. 20-2044, 2022 WL 552028 (4th Cir. Feb. 24, 2022) (Before Circuit Judges Agee, Thacker, and Quattlebaum).
This week’s notable case once again demonstrates how health insurance claims are confusing and littered with procedural and substantive land mines. This case involves one person who received treatment at one facility during one continuous period of time, yet the Fourth Circuit’s analysis of the related insurance claims submitted for that treatment has resulted in three different holdings: one regarding medical necessity, one regarding the administrator’s breach of fiduciary duty, and one regarding the claimant’s failure to properly follow procedural rules.
Continue Reading Fourth Circuit Rules That Administrator’s Failure to Respond to Claimant’s Request for Information Demonstrated Futility of Appealing